RESUMEN
Proximal femoral osteotomy has been used in cerebral palsy, Perthes disease, hip dysplasia, idiopathic femoral anteversion, and various hip diseases in children and adolescents. Conventionally, a blade plate (BP) has been used. However, the pediatric locking compression plate (LCP) has recently been applied widely. We compared the hardware-related complications of the BP and the LCP as well as the factors influencing these complications in patients who have undergone a proximal femoral osteotomy in children and adolescents. We enrolled consecutive patients aged less than or equal to 20 years who had undergone proximal femoral osteotomy with BP or LCP between May 2003 and December 2014, and who were followed up until 6 months after hardware removal. Following consensus building, hardware-related complications were identified from the patients' medical records and hip radiographs. Patient age, sex, type of plate, and Gross Motor Function Classification System (GMFCS) level in cerebral palsy patients were evaluated as possible risk factors, and a generalized estimating equation was used to assess the risk factors for hardware-related complications. A total of 417 hips from 251 patients were finally included in this study. Seven losses of fixation around the plate (five patients, 3.0%) occurred in the BP, three implant-related fractures (three patients, 3.6%) occurred in the LCP, and there was no significant difference (P=0.74). All hardware-related complications occurred in cerebral palsy patients, and the implant-related fractures occurred in patients with GMFCS IV/V. The risk of complications increased with age (P=0.002). The risk of loss of fixation around the BP is a well-known complication. However, LCP is not without hardware-related complications. The LCP provides strong stability of fixation. However, it is speculated that the LCP is related to implant-related fractures because of the stress shielding effect. Therefore, care should be exercised when using a locking plate in patients with osteoporosis, such as cerebral palsy with GMFCS IV/V. LEVEL OF EVIDENCE: Therapeutic Level III.
Asunto(s)
Placas Óseas/efectos adversos , Osteotomía/efectos adversos , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/epidemiología , Falla de Prótesis/efectos adversos , Adolescente , Placas Óseas/tendencias , Niño , Preescolar , Femenino , Humanos , Incidencia , Masculino , Osteotomía/instrumentación , Osteotomía/tendencias , Falla de Prótesis/tendencias , Estudios Retrospectivos , Factores de Riesgo , Adulto JovenRESUMEN
The scattered radiation protector for mobile x-ray systems, Creative Valuable Protector-2, has been recently developed. However, there have been no studies investigating the effects of this device. We aim to investigate the effects of the scattered radiation protector on the equivalent doses from scattered radiation delivered to radiosensitive organs while simulating spine surgery using a C-arm fluoroscope. Chest and rando phantoms were used to simulate a patient and a surgeon in this study. The equivalent dose from scattered radiation to radiosensitive organs was measured in four different situations according to the use of the scattered radiation protector and the C-arm configuration. To compare the quality of the images with and without the scattered radiation protector, an acryl step phantom with five steps was used, and the contrast resolution of each step was calculated. The equivalent dose from the scattered radiation to the surgeon's eye, thyroid, and gonad decreased significantly by using the scattered radiation protector for both the Posteroanterior (PA) (p < 0.001) and Anteroposterior (AP) (p < 0.001) C-arm configurations. The installation of the scattered radiation protector also reduced the direct radiation dose to the chest phantom. A scattered map showed that scattered radiation doses decreased by approximately 50% for the PA configuration and 75% for the AP configuration by using the scattered radiation protector. Before and after installation of the scattered radiation protector, the contrast resolution of each adjacent step area was 0.025-0.404 and 0.216-0.421. The scattered radiation protector was effective in reducing not only the equivalent dose from scattered radiation to the surgeon's radiosensitive organs, but also the direct radiation dose to the patient. This was all achieved without decreasing the quality of the C-arm fluoroscopic images.
Asunto(s)
Fluoroscopía/instrumentación , Exposición Profesional/prevención & control , Quirófanos , Protección Radiológica/instrumentación , Radiometría/instrumentación , Humanos , Fantasmas de Imagen , Dosis de Radiación , Exposición a la Radiación , Radiación Ionizante , Dispersión de RadiaciónRESUMEN
Venous thromboembolism (VTE) is a serious complication after major orthopedic surgery. This study examined the prevalence and risk factors of VTE in patients undergoing arthroplasty without thromboprophylaxis. A total of 1608 patients who underwent elective knee or hip arthroplasty between 1996 and 2009 were evaluated. The incidence of VTE was 1.99% (n = 32). Of them, 0.24% (n = 4) were diagnosed with a pulmonary embolism. The risk factors associated with VTE were female sex, revision surgery, bilateral simultaneous procedure, CVA (cerebrovascular accident; thromboembolic stroke) history, and preoperative platelet count (all P > .05). There was an annual increase in the prevalence of VTE from 1996 to 2009 (P = .002). According to these results, thromboprophylaxis is strongly recommended in high-risk groups of Korean arthroplasty patients.